After an introduction and three chapters highlighting the present state of the art in computerized electrocardiography (Chapter 2), methodological issues of medical and technical nature (Chapter 3), and electronic management of medical data storage and exchange (Chapter 4), this chapter is a midway summary. This book might end here if it were a review of present achievements of tele-medical solutions in cardiology. Fortunately, we are not only witness to the progress, but are also involved in the development of ubiquitous cardiology, so we want to share our ideas, realizations, and results of the research.
TopGeneral Overview Of The Ubiquitous Cardiology Ubiquitous Cardiology System Scope And Structure
The tele-medical system providing ubiquitous cardiac surveillance is the scope of research and prototyping in several scientific centers around the world. The subject is worth such attention because of the number of cardiac-impaired people, the sudden course of cardiac events, and the prospective participation of virtually every person in a cardiac prevention program.
According to its name, the ubiquitous cardiology system (UCS) is expected to be accessible without territorial limitations for mobile customers or patients. Therefore, the client terminal (patient electronic device, PED, see Chapter I) must be manufactured as a mobile device, preferably lightweight and small in size. Such a device would not be capable of accumulating the records of all parameters and references, therefore it has to cooperate with a management computer. This station does not have to be mobile, therefore its preferred implementation is on a workstation with a multi-threading operating system. The basic cell of the UCS consists of the supervising server and several client-side remote recorders connected according to the star topology. The connection may use a wired infrastructure, however the last section must be wireless in order to allow for mobility. The connection is bi-directional, unlike in the prevalence of today’s solutions, which assumes that data is transmitted only from the patient to the doctor. The software of a remote recorder contains not only communication, human-interaction, and data acquisition modules, but also basic interpretive procedures (Figure 1, layer one, see Chapter I). Unlike in the case of rigid software, the interpretation-oriented procedures are downloadable and commutable within limits of predefined rules. All threads in the supervising center run the same software package (layer two, see Chapter I), including the extended interpretive procedure, data-quality examination process, and remote interpretation supervising module.
Figure 1. Layered block diagram of the proposed ubiquitous cardiology system
The supervising center may be considered as an analogy of the healthcare provider. By default the supervising ends with a fully automated conclusion. In case of any doubts, a human expert on duty is alerted about possible abnormalities (layer three, see Chapter I). The expert may also be mobile, however his access to the network should support higher dataflow in order to transmit images without delay.
Central servers of territorially neighboring nodes of surveillance network are interconnected between them in order to transfer patients (like roaming service in mobile voice communication). They are also connected to the optional servers providing subscriber services of interpretation for unusual or specific cases. The concept of such a service is presented in detail in Chapter VIII. Thanks to the connections of the management center (layer four, see Chapter I), the patient or client does not have to rely on an automatically computed diagnosis and may also freely subscribe to a particular human cardiologist as a first-contact doctor, although contacted virtually. With these measures, our proposal of the UCS fulfills another principal requisite of the home care: it simulates the continuous presence of a human medical expert without limiting patient or customer mobility. Probably you never expect to have the best specialists of the world around you wherever you go!